DESCRIPTION: Body substance exposures pose a significant risk to healthcare workers of blood-borne pathogen transmission. Prevention efforts have focused on barrier precautions and more recently on safety devices, whose efficacy may vary and whose cost-effectiveness is unclear. Other risks such as organizational factors at work are still being explored. The psychological impact on healthcare workers of sustaining an exposure is poorly documented. Specific Aim 1 will determine the effect of three safety devices on needle stick injury rates, and their cost-effectiveness, in a large multi-hospital system. This healthcare system has a large, computerized occupational health database to which large and small, urban and rural, teaching and community hospitals report exposures using a common reporting form. Specific Aim 2 will address organizational factors that can affect risk of body substance exposures. A large survey of work schedules and practices of exposed workers at nine hospitals will be performed as well as a nested case-control study at the largest hospital. Specific Aim 3 will use validated psychiatric assessment tools to assess the psychological impact of sustaining an exposure both immediately after the event and at one and six month intervals. To accomplish these aims, the candidate will work with two sponsors: Dr. Victoria Fraser, a nationally recognized leader in the fields of hospital epidemiology and healthcare worker safety, and Dr. Bradley Evanoff, an occupational health specialist with a Master of Public Health (MPH) degree and extensive research experience in occupational injuries. In addition, the candidate will attend research seminars in the divisions of Infectious Diseases and General Medical Sciences and continue to pursue a MPH degree. The proposed research, classes, and mentorship will allow the candidate to become a well-trained independent investigator studying infectious risks to healthcare workers and designing and implementing interventions to improve the occupational health and safety of healthcare workers.